Has anything been more controversial or more consequential then the ongoing battle over US healthcare reform? My guest, Richard Kirsch, spent three years at the epicenter of the fight to pass the Affordable Care Act. He worked inside the Beltway, alongside and sometimes at odds with the Obama administration, and with activists across the US as head of Healthcare for America Now, a grassroots campaign of over 1,000 organizations in 46 states representing 30 million people. His new book, Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States, describes the tense relationship between progressives and the Administration, as the President and his team pushed for reform and made concessions to the healthcare industry, while trying to squelch any pressure from the left. This issue impacts every firm doing business in the US. Tune in to hear the inside story of what REALLY happened (and how) - and what it means for the future of US policy and politics.

February 13, 2012The Capitol Pressroom with Susan Arbetter

Excerpt:“First of all, I can't put this book down. Usually…I'm being totally honest…'Oh a policy book. Oh yay' let me just leave it 'til the morning before I have to interview the person. But this is great. It's a memoir. You're funny. You're a great writer. And it's fascinating reading.”

In a final excerpt from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch argues that the story of health care reform is not about any individual, but what ordinary people can achieve together with the right strategy.

The final selection from Fighting for Our Health doesn’t need an introduction. The key lesson from our campaign is that change – at least change that benefits the 99% — won’t come from elites or from Washington. When ordinary people get organized they can still do extraordinary things. But the key here is getting organized. The media likes to lift up singular “heroes” who are “making a difference.” But political change is not made by individuals on their own. Change, whether through organized campaigns like Health Care for America Now or movements with broader energy like the Occupations that broke out across America this fall, happen when masses of people come together to take action in a focused, strategic fashion.

***

If there is one lesson that I’m hoping will be learned from the campaign that HCAN ran, it is that grassroots organizing is essential to overcome the power that big corporations and wealthy elites wield. As people rose up to overthrow dictatorships in the Middle East, we witnessed that power. At home, when tens of thousands of people rallied in Wisconsin in the winter of 2011, and then translated that energy at the ballot box, we witnessed that power. But we don’t have to wait until a breaking point is reached for strategically organized campaigns that harness the aspirations of ordinary Americans to make significant change. That’s the most important decision we made at Health Care for America Now. We focused our strategy outside the Beltway by organizing a grassroots campaign built on the existing infrastructure of organizations that have a mission of winning economic justice.

At Health Care for America Now we flipped the script. We assumed that the best we could do inside the Beltway — against the army of corporate lobbyists and the bottomless war chest of corporate campaign contributors, the entrenched corporate connections of not only Republicans but of a great many Democrats, and a cynical press obsessed with the powerful and disdainful of the downtrodden — was to maintain a credible voice that could not be ignored. By using our relatively limited resources smartly, HCAN was widely quoted in the press, our television ads were seen in Washington, and we were recognized on the Hill. But if that were all we had done — along with the usual shallow investment in the field — the Affordable Care Act would not now be the law of the land.

Where we had a potential advantage over our opponents was outside the Beltway, where members of Congress and their staff still meet face-to-face with constituents, and local press corps still report on civic action. If we organized people to raise their voices together, to tell their stories, to build relationships with Congress. and if we kept doing this over and over again and did it all over the country as part of a concerted strategic effort, we could accomplish what had been impossible for the past century. And we understood that doing so required investing money in organizers to do the day-to-day work of identifying, building relationships with, and empowering people.

In an excerpt from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch notes that like Occupy Wall Street, the health care reform movement looked beyond politicians and targeted the corporate interests that were opposing progress.

When Occupy Wall Street burst onto the scene, a consistent critique was that the movement lacked an agenda and political focus. But a key factor that made OWS powerful was that it was aimed at Wall Street — a corporate target rather than a political target. At a time when most people believe that the government is a captive of the super-rich and mega-corporations, the Occupiers were going directly to the puppet masters and not bothering with the puppets.

The tension between focusing attention on the actual lawmakers and the powerful forces that control them — and their impact on people’s lives — was one that Health Care for America Now constantly balanced in running the campaign to pass health reform. One reason that we were successful is that we used this tension to drive our activism.

The public hates health insurance companies. They believe they are greedy and put profits before people’s health. This is personal for people, so many of whom have their own health insurance horror stories. We knew opponents of reform would try to scare people, making claims that they would lose their health insurance, that the government would set up death panels, and so on. We knew our best weapon against fear was anger, and that the best target for anger was health insurance companies.

At the same time, our job was to get health insurance legislation through Congress, and it wasn’t clear that demonstrations outside insurance company headquarters would move a member of Congress. We needed to be absolutely sure that members of Congress heard directly from their constituents.

This tension led our campaign to focus directly on Congress, including having many people with health insurance horror stories tell them at lobbying visits and in town hall meetings. But after the Tea Party demonstrations in the summer of 2009 fomented public anger against government, we turned our attention much more squarely on the insurance companies. We created a new national ad campaign, both on TV and in print publications read on Capitol Hill, with the theme, “If the insurance companies win, you lose.” That message tied congressional action on reform to the industry. At the grassroots, activists wrapped insurance company lobbying conferences with yellow crime tape printed with the words “it’s a crime to deny our care.”

The culmination of the effort came in early March 2010, when the legislation desperately needed a final push to get the votes necessary for it to pass the House. That is when 5,000 demonstrators carried out a citizens arrest of insurance company CEOs, waving wanted posters and signs saying, “Stop Big Insurance — Tell Congress to Listen to Us.”

***

March 9 was a glorious late winter day in the South; sixty degrees and not a cloud in sky. Five thousand demonstrators — some of whom had taken buses from as far away as Minnesota and Maine — assembled at two points, each a half mile from the Ritz Carlton. One column met at the AFL-CIO headquarters, where they were led by the federation’s president Rich Trumka, AFSCME President Gerald McEntee and American Federation of Teachers President Randi Weingarten. The other column gathered at DuPont Circle, across from the SEIU building, where I joined SEIU Secretary-Treasurer Anna Burger and Governor Howard Dean.

The marchers carried bright red stop signs that read, “Stop Big Insurance — Tell Congress to Listen to Us.” They also carried wanted posters, which brandished the names and mug shots of the CEO’s of the big health insurance companies. The wanted poster listed the criminal record of the CEOs:

Above the crowd assembled in front of the hotel, long yellow banners read “Corporate Crime Scene.” From an improvised stage on the top of an elevated flatbed truck, USAction President William McNary deputized the crowd, who together took the oath of office. They charged themselves to arrest the CEOs, “whose greed, corporate abuses, and craven lobbying pose a mortal threat to our democracy and the health and well-being of our people.”

Marcus Grimes stood on the flatbed, waving his white cane, and told the crowd, “I’m mad as hell and I’m not going to take it any more.” Marcus had a reason to be angry. The Virginia schoolteacher had lost his vision because he was uninsured and could not afford the $3,000 procedure that would have saved his eyesight. Marcus spoke as a representative of a group of twenty-six survivors of insurance company abuses.

The demonstrators filled the street in front of the Ritz Carlton, where mounted policemen tried to keep them away from the hotel entrance. A column of protestors filled the tunnel leading to the parking garage under the hotel until the police on horseback cleared them out. When several leaders tried to enter the Hilton, the police dragged them away.

In an excerpt from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch notices that FDR’s message to his supporters was “I agree with you; now make me do it.” In the health care fight, Obama’s was, “I’ve got it covered; now leave me alone.”

Since the collapse into disarray of his plan for a grand budget compromise with House Republicans this summer, President Obama has moved dramatically to appeal to the Democratic base. From his speech pushing an aggressive agenda on jobs right after Labor Day to his fiery, populist address in Kansas in December, to the State of the Union address last week, Obama has been working to accentuate the differences in his philosophy from the right rather than bending over backwards to bridge the huge gap. Behind the scenes, the White House has worked strenuously to mend another set of battered bridges — those with progressive organizations and constituency groups.

In the first year of the Obama administration, it was a very different story. As I found in leading Health Care for America Now, the administration concentrated its charm offensive on potential opponents of reform while trying to reign in any pressure from the left. Rather than following the inside/outside strategy made famous by FDR, who supposedly advised his allies to “make me do it,” the White House worked to squelch health reform supporters from fighting in or outside the beltway against legislative concessions.

The White House stance created a major dilemma for the leading progressive organizations, which were eager to work with the new Democratic administration after eight years of Bush. It took almost three full years of the president waffling, and the growing disillusionment of the Democratic base, for many organizations to begin to push more aggressively against the White House’s compromises. But that pushback was another big reason that the White House switched courses in the late summer of 2011, realizing it was running out of time to hold onto its organized base.

But in the fall of 2009, the simmering tension between the White House and Health Care for America threatened to come to a boil.

***

Early on a September morning I got a call from a member of the HCAN Steering Committee. The message was brief: Someone at the White House had called SEIU and asked that I be fired.

Whoa. I felt for a moment that I was in a movie. This couldn’t be happening to me. My mind started racing, considering how awful the White House would look if it became public that they were going after the head of a big progressive campaign for not toeing the White House line at every step. I might become a symbol for progressives of their growing alienation from the White House. But that was not what I wanted. I wanted to handle the crisis quietly and keep pushing for health reform.

Still, I was upset. When we began this journey, I had expected to take on the insurance industry, big business, the rightwing, and conservative Democrats. I never expected to be blindsided by a Democratic president, particularly when I was spending every waking moment fighting for his top priority. And I had never expected politics to be so personal.

In an excerpt from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch explains how supporters of health care reform turned the Tea Party’s own town hall tactics against them.

With Mitt Romney’s hold on the Republican nomination looking secure, the Tea Party will soon have to face the reality that despite pushing the Republican Party and its nominee to the right, they’ll wind up losing the fight in the end. This isn’t the first time. The Tea Party leapt to national prominence in August 2009, when its activists held angry and often ugly protests in town hall meetings held by Democratic members of Congress. But in the end, the biggest impact was to stiffen Republican resolve to refuse any compromises on health care while the legislation continued to make its way through Congress.

The public first got notice of the upcoming Tea Party storm in late July, when South Carolina’s Senator Jim DeMint warned that in August members of Congress would hear from “outraged” constituents. He promised that “Senators and Congressmen will come back in September afraid to vote against the American people… If we’re able to stop Obama on this it will be his Waterloo. It will break him.”

Tea Party activists delivered on the outrage, but in the biggest story of the entire health care fight missed by the press, they met their match on the battlefield that counted the most: town hall meetings held by Democratic members of Congress. It took about a week for health care supporters to organize a push back. But by August 10, most Democratic town hall meetings were filled with as many or more boosters of reform than opponents. Democratic members of Congress saw a large crowd of friendly faces, holding pro-reform signs, insisting that the meetings be civil and telling personal stories of how the health insurance industry and system were denying them the care they needed. It wasn’t powerful TV, but it was powerful politics.

As a result, when Congress returned to Washington after Labor Day, the Tea Party was stunned to see Democrats moving ahead with health reform. Instead of being defeated, President Obama strengthened his party’s resolve by giving a rousing speech that moved Democratic conferences in both Houses of Congress forward.

The following excerpt from Fighting for Our Health describes the beginning of that turn-around after a Tea Party demonstration in Philadelphia that made the national headlines.

***

On Sunday, August 2, Dr. Valerie Arkoosh, the Philadelphia physician and president of the National Physicians Alliance, was attending a large town hall meeting held in the flag-draped auditorium of the National Constitution Center. This was a modern museum dedicated to the Constitution, located two blocks from Philadelphia’s Independence Hall, the home of the Liberty Bell. The Pennsylvania HCAN coalition had recruited more than half of the 350 people who filled the hall for a meeting with Pennsylvania Senator Arlen Specter and Health and Human Services Secretary Kathleen Sebelius. Arkoosh remembers being terrified by the protestors, “I was scared. We’d had a very cursory bag check — no metal detectors. The vitriol was frightening. There were people in the room who were against the bill who had perfectly legitimate questions but they didn’t get to talk either. The tea party people would not let any factual answers to be given — if anything remotely positive was said they would start shouting. I was in awe that the two of them [Specter and Sebelius] stuck it out.”

Marc Stier, HCAN’s Pennsylvania director, was sitting next to Philadelphia Congressman Chaka Fattah, who told Stier, “You’ve got to do something.” Stier told me, “I tried to lead chants but we were outshouted. We were back on our heels. The vehemence and rudeness. Specter’s chief of staff told me that in twenty years of politics, no one had ever treated Specter like that. People kept interrupting, kept shouting about socialism, liars, high taxes, death panels. We were just not prepared for anything like this. Press reports said that the crowd was evenly divided even though three-quarters of the people were our folks.”

Marc Stier walked out of the disastrous town hall in the Constitution Center and quickly realized what every great organizer recognizes: The opposition always presents the greatest opportunities to build power. “I realized that we needed to call Carney and Dahlkemper’s offices right away.” Christopher Carney and Kathy Dahlkemper were two Democratic members of Congress from central Pennsylvania who represented conservative districts. “Up until then they would never tell us when they were holding a town hall. But that event in Philadelphia pushed them into our arms; they needed our help.” Stier continued, “If we hadn’t been doing all this work for months, sending regular delegations to their offices, meeting with them, generating press in their districts, they would have never come to us. From that point on, we got people out to all their town halls. We pretty much outnumbered the tea partiers consistently, even in rural areas. Now we had a partnership with these members of Congress.”

In an excerpt from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch notes that many small business owners support health care reform even if the organizations that claim to speak for them don’t.

Small business is iconic in America. For years, big business has cleverly used small businesses to be messengers for campaigns financed by corporate America. And anti-government, free-market orthodoxy has dictated the policies of the leading small business associations, including the National Federation of Independent Businesses (NFIB). A powerful example of NFIB clout was the key role that the association played in defeating the Clinton health care plan. If we needed any reminder of that, President Obama asked the heads of just two lobbying groups, the NFIB and the health insurance industry, to speak at the White House health summit held shortly after his inauguration.

At Health Care for America Now, it was a lesson that we took to heart. As we planned our campaign to win comprehensive health reform, we knew that we had to be able to counter the attack from small businesses. Our strategy was to invest in a fledgling small business organization called the Main Street Alliance (MSA). MSA took traditional grassroots organizing and applied it to canvassing small businesses. Starting in 2008, MSA organizers went store-to-store in shopping districts of conservative Democrats in Congress who were likely to be swing votes once we got to the legislative fight in 2009.

The MSA organizers identified small business people who were angry at the health insurance industry for skyrocketing premiums and shrinking health benefits. As Rick Poore, the owner of a Nebraska business that designed custom T-shirts, told me, “Insurance companies are like potato chip manufacturers — they put less in the bag and charge more.”

MSA fulfilled its promise, with many of the small business owners it canvassed becoming powerful spokespeople and grassroots lobbyists. One of them, Dan Sherry, lived in the congressional district of Rep. Melissa Bean, a conservative Democrat from the Chicago suburbs. Sherry’s daughter went to high school with Bean. As part of the Health Care for America Now coalition in Chicago, Sherry joined fellow activists in running an aggressive and ultimately successful campaign to win Bean’s vote. Here is how Sherry’s story begins.

***

“If I had not gone to the doctor for a checkup, you and I would never have met,” Dan Sherry said as he shared his story on his 53rd birthday in August 2010. The doctor found nothing more than elevated cholesterol. Yet his insurance company’s reaction would turn Dan from an armchair activist into a national leader in the fight for health care, taking him to the White House, where he met the president, and to the steps of the Capitol, where Speaker Pelosi invited him to tell his story to the national press corps. Most important, he would sway his own member of Congress, conservative Illinois Democrat Melissa Bean. The complement to HCAN’s strategy of creating strong congressional champions was winning the support of “swing” members of Congress like Bean.

Sherry grew up south of Boston, and you can still hear a trace of a Boston accent in his voice. His wife Marcia’s family had a small business in the Chicago suburb of Evanston, making pet tags. Dan and Marcia both wearied of working for big corporations that left them with little control over their lives and decided to go into the family business. With 120 million dogs and cats in the U.S., they recognized the huge potential for growing the business. Within a few years, their revenues had grown twenty-fold. When the advent of big chain stores like Petco and Petsmart threatened their business, Dan opened up a trophy and award business. He even invented a board game to play with a dog that became the rage in the dog obedience world, called “My Dog Can Do That!”

Ironically, the explosive growth of their pet tag business caused Dan Sherry to lose his health insurance. In the summer of 2003 he received an order for 100,000 pet tags. In the rush of trying to deliver such a huge order, Sherry missed one payment on the high-deductible health insurance plan that he had been purchasing for fifteen years. “With such a high deductible, we’d never used the insurance, even when our children were born. When I tried to make the missed payment, they said they first wanted to see our medical records. I hadn’t been to a doctor in years. And I’d even run the Chicago Marathon two years earlier. But in spring of 2003, I had decided to get a checkup and sure enough, they found high cholesterol. Since then I’ve had an MRI and my pipes are clean as a whistle. But the insurance company refused to cover me. It agreed to take my wife and children but jacked up our rates. I was left uninsured. I looked for other coverage, but once you get rejected, the insurance companies share their data. I went years without insurance and was really angry. Until you’ve walked in the shoes of someone without insurance, you don’t know what it means.”

In 2008 Jamie Meerdink, the Main Street Alliance organizer in Illinois, walked into Dan’s store and asked him to sign a petition to support health care reform. Sherry remembered, “Jamie asked if I had a story. His timing was perfect. I had just seen a lawyer who told me that the only way to protect my wife and kids from the medical costs that would result if I got seriously ill was to get divorced and give my wife the house, the car and all the savings.” Jamie invited Sherry to MSA’s first meeting in Illinois. “I had no idea of what I was getting involved in. I couldn’t tell if they were well organized or not. But I was intrigued about getting involved in a grassroots organization. You literally took someone who was feeling angry, alone, impotent, frustrated and took me to the steps of the Capitol and I’m really appreciative of the entire journey.”

In the first of a series of excerpts from his new book, Fighting for Our Health, Roosevelt Institute Senior Fellow Richard Kirsch explains how Scott Brown’s upset victory threw the fate of health care reform into doubt.

How many lives does health care reform have? The law has survived a slew of near-death moments, but 2012 brings new lethal traps for the first-ever law that makes health coverage a right for almost all Americans.

First up is the U.S. Supreme Court, which will hold three days of hearings on various aspects of the constitutionality of the Affordable Care Act at the end of March. Sometime before July 4 we will learn whether the law — in whole or in part — survives that challenge.

The next potentially lethal threat to the health care law will be the presidential and congressional elections. If a Republican wins the presidency, he’ll be obligated to try to kill the health care law. Even if President Obama wins reelection, an unfavorable Supreme Court decision may force new legislative action, throwing major parts of the law into doubt.

None of this should be surprising. Despite the odds, the legislation that became the Patient Protection and Affordable Care Act survived a grueling gauntlet of stolid Republican opposition, maddened tea partiers and right-wing Democrats, and tens of millions of health insurance dollars funneled through the U.S. Chamber of Commerce. It’s already been through at least nine lives.

My new book, Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States, recounts one way that the law beat the odds: for the first time in the long-failed history of attempts to make health care a public right, there was a well-organized and funded grassroots campaign behind the effort. And at crucial times when the law was hearing its death knells, our grassroots campaign helped it rise to its feet. My book begins with the most unlikely of those mortal moments: the election of a Republican to Ted Kennedy’s seat in the Senate.

***

There’s nothing like getting your hopes crushed to pieces. I rushed into Ethan’s office to get on the phone with Saul Shorr, a brilliant bulldog of an ad man who had created our TV ads for the past five months. This was a conversation that I’d been looking forward to for more than a year. We were going to discuss the final ad campaign to help push the health care bill through Congress. The bill had survived the nasty Tea Party attacks in August, tens of millions of dollars in negative ads aimed at vulnerable Democrats up for reelection, and multiple Republican filibusters in the Senate. The press had written the health care bill’s obituary over and over again. Now the president and congressional leadership were only a few days from completing negotiations on a final agreement.

Shorr put a halt to the discussion before we had even begun.

“I hate to throw water on this whole thing, but I wouldn’t count on having a deal after Tuesday.”

I hadn’t been thinking at all about the Massachusetts special election for U.S. Senate, set for January 19, 2010. We’d heard that the Democratic candidate, Attorney General Martha Coakley, had made some blunders, but this was Massachusetts, the state that had mourned Edward Kennedy’s passing just a few short months before…

I didn’t want to believe Saul. I’m an optimist. You have to be in my business. But I knew in my gut that Saul was right. I was sick to my stomach for several hours. Could health care reform really all slip away? Ever since we had beaten back the Tea Party in August I’d been confident of the outcome. But Election Day is what most matters to elected officials. A defeat at the ballot box is the most powerful rebuke, capable of snatching defeat from the jaws of victory…

Almost three years ago to the day of Scott Brown’s election, in January 2007, I’d had the first conversation with colleagues about creating a campaign to pass comprehensive health reform, anticipating the election of a Democrat as president in 2008. For the past fifteen months Health Care for America Now — HCAN for short — had been organizing Americans around the country, so that we would be ready for these kinds of moments. We knew that finally making health care a right in the United States would be a monumental struggle. It was our job to carry members of Congress through the darkest storm. I still believed we would win the prize that had eluded presidents and progressive activists for almost a century.

January 18, 2012by Richard Kirsch

I woke up New Year’s morning with a nervous stomach. It was finally 2012, the year that I’d been talking about casually since people started asking me, “will the Affordable Care Act survive?” As I wrote in the epilogue to my new book, Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States, health reform has to jump two big hurdles in 2012 to survive. The first is the Supreme Court ruling on its constitutionality, with three days of oral arguments in March now just a few weeks away. The second, of course, is the election for President.

On the campaign trail in Iowa, Rick Santorum baldly revealed why the right is so intent on killing the promise of good health care for all: Santorum said it would make people “dependent” on the government. As I write in my book: “The right understands that if the Affordable Care Act is implemented, it will create a bond between the American people and government, just as Social Security and Medicare have done. The last thing that the corporate and ideological right want is for a new health care pillar to be added to the foundations of government social insurance.”

The battle over the Affordable Care Act needs to be understood in its historic context. While the legislation that passed was certainly compromised from an ideal law, it will for the first time – when its key measures are implemented in 2014 –establish a government responsibility to make decent health care affordable to almost everyone. Following a century of failure, during which the United States emerged as the only developed nation to guarantee health care, the passage of the ACA needs to be understood as a remarkable accomplishment.

That history weighed over the battle that began in 2008, when I helped found Health Care for America Now(HCAN), a coalition that as health care historian Paul Starr told me, was the first time that there was a major grassroots, field campaign to pass reform. Fighting for Our Health is the story of that campaign, starting from its early roots in 2003, when Yale professor Jacob Hacker pdf) and I (pdf) separately developed a new policy approach, the public option. We each envisioned the public option as a way to bridge the gap between those who championed single-payer government health insurance and reforms based on expanding private health coverage. As I write: “It is impossible to overstate how important the idea of the public option was to creating the powerful unified coalition that became HCAN.”

The story of how Marcelas Owens ended up at the White House is one of many that I tell in Fighting for Our Health, each aimed at capturing the drama and illuminating the strategy that drove us to victory. I describe:

How we thanked House Democrats who voted for the bill and spanked Democrats who voted against it in 2009, a key strategy in getting a majority of House members to vote for the final legislation in 2010.

At the end of the day though, we were all on the same side, celebrating passage of legislation that – if it survives 2012 – will make affordable health care a right in the United States. To see that promise fulfilled, we’ll need the President, Congressional Democrats and activists to make it clear why the Affordable Care Act will be a huge step forward in creating a country that works for the 99%. We’ll need to remind the public that once the ACA is implemented in 2014, it will mean that losing your job, retiring early, or starting a small business won’t result in losing access to affordable health coverage. It won’t mean you could go medically bankrupt.

The ACA became law because of the passion of activists and Democratic elected officials for creating a more just America. We defeated the Republican part, the tea party, the U.S. Chamber of Commerce and the health insurance industry. In 2012, we need to do it again.